A Case of Prenatal Diagnosis of Congenital Total AV Block on VSD and PDA with Ultrasound

Objective : To report the diagnosis and management of congenital total AV block on VSD and PDA in pregnancy.Method : A case reportCase : A 37-year-old multiparous woman G4P3A0H2 24- 25 weeks of preterm pregnancy with fetal bradycardia, VSD, PDA with ultrasonography and CTG results was FHR 70 bpm. At 37- 38 weeks of pregnancy, termination of pregnancy was performed by cesarean delivery with preparation for complication of fetal AV block. A male baby was born with weight 2600 gram and APGAR score of 8/9. Immediate echocardiography result was situs solitus, VSD PM LR shunt, PDA LR shunt, good left ventricular function, left aortic arch and EF 74%. ECG result was sinus bradycardia, total AV block with junctional escape rhythm. Sternotomy and PPM implantation was performed by cardiothoracic surgeon three hours after the baby was born. Post PPM implantation, ECG results was HR 165 bpm and chest X- rays interpretation was cardiomegaly with plethora. Mother and baby came home in good condition on the 6th day of treatment. On the next baby’s control at 4.5 months obtained a weight of 5.4 kg with the echocardiography results was solitus, VSD PM LàR shunt, VSD muscular multiple 3 pieces LàR shunt, PDA LàR shunt, good right and left ventricular function, and left arch. The child got captopril 2x1.5 mg and planned for a 6-month repeat echocardiography.Conclusion : Congenital of total AV block on VSD and PDA is confirmed by prenatal diagnosis and preparation for comprehensive multidisciplinary management.Keywords: congenital total AV block, fetal bradycardia, fetal echocardiography, PPM, ultrasound

Difficulty in Diagnosing Peritoneal Fluid Cytology in Ovarian Yolk Sac Tumor Cases

Objective : This article objective is to describe cytology diagnosis difficulties of yolk sac tumors of the ovary.Method : Case reports and literature review.Case : The author reports the case of a 24 year old woman who complained of an enlarged stomach. Serum AFP increased to 16,519.7 U/mL. Ultrasound examination revealed solid and irregular mass of ovarian, so the conclusion was suspect ovarian carcinoma. Conclusion of CT scan examination was a solid ovarian tumor. The working diagnosis was suspect ovarian carcinoma. Optimal debulking was performed, accompanied by taking a sample from the peritoneal rinse fluid. Microscopic examination of peritoneal fluid showed the distribution and group of cells with pleomorphic nuclei, partly hyperchromatic, partly vesicular with coarse chromatin and prominent nucleoli. There were also cells with polygonal nuclei, small nuclei, basophilic and vacuole cytoplasm with a mucoid background. These cells formed a solid arrangement. Conclusion from these features was carcinoma metastases to the peritoneal fluid. Microscopic examination from tumor tissue sample showed an ovarian yolk sac tumor appearance.Conclusion : Cytologic examination of peritoneal fluid in cases of ovarian yolk sac tumor is quite difficult to determine the diagnosis. This is due to the microscopic appearance of tumor cells which often looks like a carcinoma and limited literature about this tumors in the peritoneal fluid.Keywords: Yolk sac tumor, ovary,

The Effect of Giving Virgin Coconut Oil (VCO) to Changes in Lauric Acid Levels in Breast Milk

Breastmilk (ASI) is the best food produced by the breast glands, containing all the nutritional elements needed by infants aged 0-6 months. Apart from nutrients, breast milk also has other non-nutritional components that act as immune factors for babies. Babies who are not exclusively breastfed will be more susceptible to chronic diseases, such as heart disease, hypertension, and diabetes as adults and can suffer from malnutrition and obesity. Dietary intake significantly affects milk production. The mother's diet can affect the composition of her milk through several metabolic pathways, especially the concentration of fatty acids and vitamins that are soluble in fat and water, including vitamins A, C, B6, and B12. Lauric acid contained in breast milk can help your minor fight infection and increase immunity to protect from various diseases. Not only for the baby, but virgin coconut oil is also starting to be commonly used by dieters. Virgin coconut oil contains lauric acid CH3 (CH2) 10COOH 50% and caprylic acid CH3 (CH2) 6COOH 7%. Both of these acids are medium-chain saturated fatty acids that are quickly metabolized and have anti-microbial properties. The benefits of virgin coconut oil (VCO) are that it is beneficial for the health of the body, including being antibacterial, antiviral, anti-fungal, and natural anti-protozoa; helps relieve symptoms and reduces health risks associated with diabetes, helps protect against osteoporosis, helps prevent high blood pressure, helps prevent liver disease, keeps the heart and blood vessels healthy, helps prevent cancer, helps you lose weight, maintain stamina, maintain healthy skin and hair.Keywords: Breastmilk, Lauric Acid, VCO

Correlation of Ferritine and Brain Derived Neurotrophic Factor (BDNF) Levels in Preeclampsia

Iron deficiency anemia that followed by low serum ferritin levels in early pregnancy has an indirect impact on decreasing the expression of Brain Derived Neurotrophic Factor (BDNF) in the maternal hippocampus. BDNF together with its receptor tyrosine kinase B (TrkB) induced the expression of metalloproteinase-9 (MMP-9) which plays an important role in blastocyst implantation, trophoblast invasion and placental development. Decreasing BDNF levels can interfere with those process which caused imbalance of pro-angiogenic and anti-angiogenic factors such as VEGF, PIGF, sFlt1 and sEng that leads to preeclampsia. This study aims to determine the correlation between ferritin and BDNF serum levels in preeclampsia.Keywords: Preeclampsia, ferritin, iron deficiency anemia, Brain Derived Neurotrophic Factor

The Correlation of the Average Increase in Blood Magnesium Levels with the Incidence of Preeclampsia After Magnesium Supplementation in Hypomagnesemic Pregnant Women at the Padang City Health Center

Preeclampsia is a hypertensive disorder in pregnancy that occurs in 5-10% of pregnancies and occurs after 20 weeks of gestation and recovers spontaneously after delivery. Several studies have stated that one of the risks of hypertension in pregnancy is related to magnesium homeostasis. Magnesium plays an important role in forming new tissues (maternal and fetal). Pregnant women need a higher intake of magnesium than non-pregnant women of the same age. Magnesium deficiency during pregnancy not only causes problems for the nutrition of pregnant women and fetuses, but also associated with the occurrence of preeclampsia, preterm labor and muscle cramps during pregnancy. This study aims to determine the relationship between the average increase in blood magnesium levels with the incidence of preeclampsia in hypomagnesemic pregnant women.Keywords: preeclampsia, hypertension, blood magnesium levels

Effect of Virgin Coconut Oil in The Treatment of Leucorrhea Caused by Candida Albicans Infection on Pregnant Women at Hospitals in Padang

Introduction : According to WHO, the prevalence of reproductive health problems in women has reached 33% from all types of diseases. One of the most frequent reproductive health problems is fluor albus. The incidence of candidiasis in pregnant women has doubly increased, especially at third trimester, compared to women who were not pregnant. Candida should be considered a dangerous pathogen in early pregnancy.Objective : This study compared the number of colonies before and after the administration of virgin coconut oil (VCO) to address vaginal discharge caused by C. albicans infection in pregnant women.Material and methods : This is an experimental study on 36 pregnant women. Examination of fluor albus is done by applying vaginal swab before and after administration of 1 tablespoon of VCO orally three times a day dan 5cc of VCO was applied on the vagina and vulva for intervention group, meanwhile the control group was not given anything. Statistical analysis to test the significance is done by using T-test.Results : There was a difference on average number of colonies with higher number of colonies prior to administration (137.17 ± 16.35 vs 122.17 ± 14.42). The average number of colonies at the first examination was 96.06 ± 8.85 colonies and increased at the second examination to 112.89 ± 12.49 colonies.Conclusion : There was an effect of VCO administration on decreasing the number of colonies in the intervention group (p=0.000), while in control group, there was increasing average number of colonies in the second examination (p=0.000).Keywords: Candida albicans, fluor albus, pregnant women, virgin coconut oil

Diagnostic Test On Modified Score Of Cesarean Section History In Placenta Accreta Index In Predicting Placenta Accreta Diagnosis In Rsup Dr M Djamil

Introduction : Placenta accreta is defined as abnormal implantation of placenta villi which invades myometrium without the presence of decidua bacalis resulting in placenta that is difficult to remove. Based on the depth of invasion, placenta accreta is divided into three grades, placenta accreta, placenta increta, and placenta percreta. Placenta accreta developes if chorionic villi attaches to endometrium beyond desidua basalis. Placenta increta develops when chorionic villi invades the whole myometrium. Placenta percreta developes when chorionic villi attaches beyond myometrium reaching serous and abdominal organ. Based on clinical manifestation, placenta accreta is the common term being used. Incident of abnormal placenta invasion varies from 1 : 93.000 up to 1 : 540 pregnancy. PA incidence had increased four times from 1994 to 2002 in line with increased of caesarean section procedure. Other study showed history of caesarean section increased risk of placenta accreta up to 8,7 times. Placenta accreta index (PAI) was developed based on scoring process or various parameters assessment to help diagnose placenta accreta. The parameters including: history of caesarean section ≥ 2 times, lacunae grade, sagittal smallest myometrial thickness, anterior placenta previa and birding vessel. High PAI indicates high risk of abnormal placenta invasion based on histology.Objective : This study aims to investigate modified history of cesarean section score in placenta accreta index in predicting placenta accreta diagnosis in RSUP DR M Djamil Padang.Material and methods : This was analytical study with cross sectional design. Study population was 84 placenta accreta patients in RSUP Dr. M. Djamil Padang from 2016 to 2019. Study sample was recruited using simple random sampling technique after meeting inclusion and exclusion criteria. Statistic analysis was done using Cohen’s Kappa test. Diagnostic test including sensiticivy, specivicity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy.Result : Strenght of agreement diagnosis placenta accreta based on PAI showed Kappa score of -0,002 (Kappa score < 0,2) which indicated poor strength of agreement. Strenght of agreement diagnosis placenta accreta based on modified PAI showed Kappa score of 0,353 (Kappa score range from 0,21 to 0,40) which indicated fair strength of agreement. PAI diagnostic test yield sensitivity of 97,1%, specificity of 2,8%, positive predictive value of 48,5%, negative predictive value of 50%, and accuracy of 48,6%. Modified PAI diagnostic test yield sensitivity of 97,1%, specificity of 38,9%, positive predictive value of 60%, negative predictive value of 93,3%, and accuracy of 67,1%.Conclusion : PAI has high sensitivity, low specificity, moderate positive predictive value, moderate negative predictive value, and moderate accuration. Modified PAI has high sensitivity, moderate specificity, moderate positive predictive value, high negative predictive value, and high accuracy. PAI diagnosis has poor strength of agreement compared with pathology anatomy. Modified PAI diagnosis has fair strength of agreement compared with pathology anatomy. Modified PAI has identical sensitivity with standard PAI, meanwhile for specificity, positive predictive value, negative predictive value, and accuracy, modified PAI yields higher result compared to PAI.Keywords: Modified score of history caesarean section, placenta accreta index, Modified placenta accreta index, diagnostic test of placenta accreta diagnosis

Correlation Between Levels of Interleukin-6 in Peritoneal Fluid With Degree of Pain, Adhesion, and Endometriosis Fertility Index Score in Endometriosis

Introduction : Endometriosis is a benign gynecological disorder characterized by the presence of endometrial tissue and stroma outside the uterine cavity. Several theories have been proposed to explain the occurrence of endometriosis, one of which is the theory of inflammation. Endometriosis lesions can produce inflammatory cytokines, resulting in their increased levels in the peritoneal fluid. This process causes disruption in pelvic anatomy, ovarian function, prostaglandin production and growth factor production that causes pain, adhesions and infertility. Interleukin-6 (IL-6) is an important and potential inflammatory cytokine in assisting the diagnosis of endometriosis. These cytokines act as activating macrophages that can stimulate endometrial cell proliferation and modulate the secretion of other cytokines such as IL-10, IL-13 and TNF-α which augments the inflammatory process. High levels of IL-6 in the peritoneum are relatedto advanced endometriosis associated with pain, severe pelvic adhesions and embryotoxic effects leading to infertility. The effect of IL-6, both local and systemic, on the growth of endometriosis lesions and its associated symptoms is great that this cytokine is considered an important marker.Objective : This study aims to determine the relationship between local inflammatory factors (IL-6 in peritoneal fluid) obtained during laparoscopy with the degree of pain, the degree of adhesions and the correlation with the Endometriosis Fertility Index (EFI) score in endometriosis patients.Material and methods : This is a quantitative analytic research with a cross sectional study design which was conducted on 22 patients with endometriosis. Prior to the laparoscopy, historical factor (EFI score) was recorded and an assessment of the pain scale was performed by filling out a questionnaire. Intraoperatively, the peritoneal fluid was obtained. If the peritoneal fluid was found, it was taken directly with a volume of 3-5 cc using 10 cc syringe. If no fluid was found, peritoneal rinsing was performed using 0.9% NaCl fluid, then 3-5 cc fluid was aspirated using a 10 cc syringe. Subsequently, an examination was carried out using the RayBio Human IL-6 ELISA Kit. During the laparoscopy procedure, the degree of adhesion of the pelvic organs was assessed by looking at the shape and how the adhesions can be separated. Surgical factor (EFI score) was assessed intraoperatively to obtain data for the least function score, AFS endometriosis score and AFS total score. Statistical analysis was performed using paired t test and correlation test.Results : The mean age of the respondents was 34.86 ± 6.11 years, 81.8% were nulliparous, 100% were married, 100% experienced both primary and secondary infertility and 81.8% had no prior pregnancy history. In the study, it was found that IL-6 levels of peritoneal fluid were higher in patients with the degree of severe pain (P <0.05) compared to moderate with the results of 32.58 ± 7.31 pg/ml and 25.39 ± 2.70 pg/ml. IL-6 levels were found to be higher in grade three adhesions than grade two (P <0.05) with results of 32.78 ± 6.65 pg/ml and 23.86 ± 2.18 pg/ml. The mean peritoneal fluid IL-6 levels were 30.75 ± 7.01 pg/ml and the mean EFI score was 4.09 ± 2.09. The correlation of IL-6 levels in peritoneal fluid with EFI score showed a value of r = -0.448 which had moderate strength and a negative pattern, indicating that the higher the IL-6 level of peritoneal fluid, the lower the EFI score (P <0.05).Conclusion : There is a relationship between IL-6 levels of peritoneal fluid in endometriosis with the degree of pain and the degree of adhesion, where IL-6 levels were found to be higher in the degree of severe than moderate pain (P <0.05), higher in third degree adhesions than second degree ( P <0.05). There was a correlation between IL-6 levels of peritoneal fluid with EFI score (P <0.05) with a negative pattern of moderate strength analysis results (r = -0.448).Keywords: Endometriosis, Interleukin-6, Degree of Pain, Degree of Adhesion, Endometriosis Fertility Index Score

Correlation of Brain Derived Neurotrophic Factors (BDNF) With Maternal and Perinatal Outcome in Preeclampsia

Objective: To analyze the correlation between BDNF and maternal and perinatal outcomes in preeclampsia.Methods: This was an observational analytic study with a cross-sectional design on 73 pregnant women with preeclampsia. The study began in January 2020 to June 2020 in the Obstetrics and Gynecology Department of Dr M. Djamil Hospital Padang.Results: The mean BDNF levels of pregnant women with preeclampsia were 519.9± 325.4 pg/ml. The correlation between BDNF and systolic blood pressure, diastolic blood pressure, and Mean Arterial Pressure was negatively correlated (r = -0.145, -0.1, and -0.218), with a weak correlation. There was no statistically significant relationship between BDNF and systolic blood pressure, diastolic blood pressure, and mean arterial pressure (p> 0.05). BDNF correlation with infant birth weight and the birth length was positively correlated (0.196 and 0.205) with a weak correlation. The correlation between BDNF level and Apgar score was negatively correlated (-0.039 and -0.054) with a weak correlation. There was no statistically significant correlation between BDNF with birth weight, birth length, and Apgar score (p> 0.05).Conclusion: The mean BDNF level in preeclampsia was lower than normal pregnancy, there was a negative correlation between BDNF levels and maternal outcomes in preeclampsia with a weak correlation. There was a positive correlation between BDNF levels and perinatal outcomes (birth weight and birth length) in preeclampsia and there was a negative correlation between BDNF levels and Apgar score in preeclampsia with a weak correlation.Keywords: Brain Derived Neurotrophic Factors, Preeclampsia, Maternal Outcome, Perinatal Outcome

Differences of Increased Bishop Scores Between Neutrophil Swab Vaginal ≤ 5 and > 5 in 41 Weeks of Pregnancy Induced With Misoprostol

The incidence of labor induction with various indications was to increase. The key to successful labor induction is a ripe cervix. Research shows that the degree of cervical rippening as assessed by the Bishop score is influenced by the level of neutrophils contained in the cervical stroma which can be detected by performing a vaginal swab. Neutrophils will produce collagenase in the form of matrix metalloproteinase - 8 (MMPs - 8) which will degrade cervical collagen fibers, so that the cervix becomes soft and ripe. Misoprostol is the drug most widely used in labor induction today. Purpose: This study was to determine the difference in Bishop score increase between vaginal swab neutrophils ≤ 5 and > 5 in pregnancy ≥ 41 weeks induced by misoprostol.Keywords: Bishop score, neutrophil, vaginal swab, misoprostol